Midwifery Exam Paper Registration

**Whakapapa-** *The wahine and her whanau is acknowledged* **Karakia-** *The wahine and her whanau may use karakia* **Whanaungatanga-** *The wahine and her whanau may involve others in her birthing programme* **Te Reo Maori-** *The wahine and her whanau may speak Te Reo Maori* **Mana-** *The dig...

**Whakapapa-** *The wahine and her whanau is acknowledged* **Karakia-** *The wahine and her whanau may use karakia* **Whanaungatanga-** *The wahine and her whanau may involve others in her birthing programme* **Te Reo Maori-** *The wahine and her whanau may speak Te Reo Maori* **Mana-** *The dignity of the wahine, her whanau, the midwife and others involved is maintained* **Hau Ora-** *The physical, spiritual, emotional and mental wellbeing of the wahine and her whanau is promoted and maintained* **Tikanga Whenua-** *Maintains the continuous relationship to land, life and nourishment; and the knowledge and support of kaumatua and whanau is available* **Te Whare Tangata-** *The wahine is acknowledged, protected, nurtured and respected as Te Whare Tangata (the "House of the People")* **Mokopuna-** *The mokopuna is unique, cared for and inherits the future, a healthy environment, wai u and whanau* **Manaakitanga-** *The midwife is a key person with a clear role and shares with the wahine and her whanau the goal of a safe, healthy, birthing outcome* **Te Whare Tapa Wha- model of holistic healthcare by Mason Durie** **Cultural competence is the ability to interact respectfully and effectively with persons from backgrounds different to one's own. For midwives, cultural competence means both recognising the impact of one's own culture and belief on their midwifery practise and being able to acknowledge and incorporate ach woman's culture into the provision of individualistic care. It means having the knowledge, skills and attitude to understand the effect of power within a health care relationship and to develop respectful relationship with people of different cultures.** **Pepara-** father **Kaumate**- elders **Whakakura**- woven flax sleeping device **Noa**- normal, unrestricted **Mana**- prestige **Utu**- karma **Adoption**- The interim order is signed 12 days after the birth with the final order occurring at least six months later. The birth mother must complete the birth registration no matter her age. Social workers and other appropriate state agencies must be involved. Adoptees can block contact from 19 years and request birth parent information from 20 years. **Registration**- Births, Deaths, Marriages & Relationship Registration Act 1995 Following the birth of an infant (either stillborn or live birth) a **notification of birth** BDM9 must be completed by the midwife with 5 working days of delivery. Both parents (if both are available and can cooperate on the matter) are required to complete a **Registrar of birth** BDM27 along with their personal details and citizenship information, within 2 months. A **death certificate BDM167** is required before in cases of stillbirths before the remains can be buried or cremated, no more than 5 days after death. The funeral director will complete a death notification no more than 3 days after disposal. Deaths reported to the Coroner must be notified to the Registar. The Medicines Amendment Act (2013) and Misuse of Drugs Regulation Amendments (2014) allow midwives who have completed the required education to prescribe the controlled drugs morphine and fentanyl, in addition to pethidine for intrapartum (labour, birth and immediate postpartum period) use only. - Descent, flexion, internal rotation, crowning, extension, restitution, internal rotation (shoulders), external rotation (head), shoulders, lateral flexion - **Vertex Presentation**- occiput - Fully flexed **suboccipitobregmatic 9.5cm** - Partially deflexed **suboccipitofrontal 10.5cm** - Fully deflexed **occipitofrontal 11.5cm** - **Face Presentation**- mentum - Extended **submentibregamtic 9.5cm** - Not fully extended **submentrovertical 11.5cm** - Can only birth if mentum is anterior, the chin will escape under the symphsis pubis. Flexion will allow the occiput to sweep the perineum. Posterior face presentation will see the chin wedge of the anterior surface of the scarum. - **Brow Presentation**- glabella or frontum, caught between extension and flexion - **Mentovertical** or **occiptomento 13.5 - 14cm** - Cannot birth vaginally, as diameter cannot descend into the pelvis. Sagittal suture will be in the transverse or oblique pelvis, bregma and orbital ridges are palpable. - **Occiptoposterior** - Partially flexed **occipitofrontal 11.5cm** - Occiput lies adjacent to the sacro-iliac joint, the sinciput of the fetal head faces the ileo-pectineal eminence. OP position occurs in approximately 10-25% of all labours, 10-15% of active stage. - **Long rotation**- As the descent continue, flexion increases, and the occiput meets the resistance of the pelvic floor, occiput rotates 135° (3/8th) anteriorly until the sagittal suture lies in the AP diameter of the pelvic outlet. Birth will proceed as for an OA position.  - **Short rotation, persistent occipito-posterior position-** Descent occurs with deficient flexion and the biparietal diameter (9.5cm) is held up on the sacrocotyloid diameter of the pelvis (sacral promontory to the iliopectineal eminence, 9.5cm). The sinciput becomes the leading part and rotates 45° or 1/8 of a circle anteriorly. The sagittal suture then lies in the AP diameter of the pelvic outlet. Crowning occurs, the occiput sweeps the perineum and the head is born by flexion. This is followed by extension to birth the fetal head from under the symphysis pubis. Moulding- reduction in the occipitiofrontal and increase in the mentovertical diameter. - **Deep Transverse Arrest**- The occiput starts the long rotation but flexion is not maintained and the occipito-frontal diameter (11.5cm) becomes caught in the transverse diameter of the outlet, between the ischial spines. If a vaginal examination is performed, the midwife will find the sagittal suture in the transverse diameter and both anterior and posterior fontanelles will be palpable.  - **Bisacromial diameter 9.5cm** - **Bitrochanteric diameter 9.5-10cm** - **First degree tear-** Injury to the perineal skin and/or vaginal mucosa - **Second degree tear-** Injury to the perineum involving perineal muscles, no involvement of anal structures - **Third degree tear-** Injury to the perineum involving the anal sphincter complex - **3A-** less than 50% of the external anal sphincter thickness is torn - **3B-** more than 50% of the external anal sphincter thickness is torn - **3c-** both the external anal sphincter and internal anal sphincter are torn - **Fourth degree tear-** Injury to the perineum involving the anal sphincter complex and anorectal mucosa - The muscles cut during an episiotomy are the **transverse perineal muscle, bulbocavernosus, lliococcygenus** and **pubocooygenus.** - **Mediolateral-** the incision starts in the midline of the fourchette and runs backwards to a point between the ischial tuberosity and anus. This type of incision appears to be less likely to extend to a third or fourth degree tear, but is more painful during healing and tends to bleed more\ **Midline-** the incision is from the fourchette directly down towards to anus. It is associated with less pain and bleeding, although there is an increased risk that it will extend.\ **Anterior**- women with female genital mutilation type 3 infibulation may require an anterior episiotomy. - **How to suture**: Starting point from above APEX, from vaginal to muscle layer to subcutaneous layer. 1cm above the apex a loose continuous unlocked suture the posterior vaginal wall and continuous suture for the muscle layer, a continuous subcutaneous perineal skin suture. Or from outside to inside. **FSH**- along with oestrogen produced by the ovaries act on the granulosa cells of the follicle to stimulate growth and LH receptors. - **LH**- acts on theca cells instigating the production of oestrogen by granulosa cells. This increase in oestrogen inhibits the development of other follicles by inhibiting FSH (negative feedback) - The ovum only survives 12-24 hours after ovulation with sperm only surviving 24 hours in the female productive tract. Sperm needs 4-10 hours in the female reproductive tract before they are capable of fertilising an ovum (progesterone stimulates the acrosomal reaction). Sexual intercourse 24 hours prior to or 12 hours after ovulation may result in fertilisation. - **Syngamy**- prevents only one sperm cell to fertilise an ovum, change in the electrical potential & chemical composition of the zona pellucida. - The zygote remains in the ampulla of the fallopian tube for roughly **24 hours** and is then swept towards the uterus by ciliary action over the next **3-4 days**. The zygote undergoes repeated mitotic division or cleavage as it moves towards to uterus. Cleavage increases the number of cells (**blastomeres**) but not their total size due to them being contained within the zona pellucida. The cytoplasm of the ovum provides energy and nutrients for the mitotic division. The first cell division into the two cell stage occurs around **30 hours** after fertilisation. Further division occurs every 12-24 hours. By **day 3** there is 12-15 blastomeres which form a solid cluster within the zona pellucida known as the **morula**. The **morula** enters the uterine cavity at **day 4-5** and as uterine secretions pass through the zona pellucida into the morula a fluid filled cavity, **blastocyst cavity**, is formed. As this cavity forms the surrounding blastomere separates into two areas; - **Trophoblastic**- the thin layer of cells around the outside that give rise to the **fetal part of the placenta** (the **chorion**) - **Inner cell mass**- the inner group of blastomeres that give rise to the **embryo**, yolk sac and **amnion**. - **Blastocole-** empty space, form yolk sac The conceptus is now known as a **blastocyst** which floats within the uterine cavity for roughly 2 days as the zona pellucida disintegrates. Approximately **6 days** after fertilisation the blastocyst begins **implantation**. - The trophoblast differentiates into two layers the outer **syncytiotrophoblast** (maternal side of the placenta, release enzymes into maternal endometrium to form lacunae by **day 9**) and the inner **cytrotrophoblast** (fetal side of the placenta, formed **syncytial cells**- the **chorionic villi**) - **Decidua basalis-** the region beneath the site of implantation, develops into the maternal region of the placenta - **Decidua capsularis-** the area covering the implantation site, disappears when chorion develops. - **Decidua parietalis vera-** the remainder of the uterine lining, eventually fuses with the chorion. - The inner cell mass forms a layer of **hypoblasts** around day 7 (formation of the bilaminar disc- hypoblast & epiblast cell layers, completed at day 8). Three to eight weeks following fertilisation is known as the embryonic stage. - **Ectoderm-** nervous system (brain and spinal cord) & skin, amnion - **Mesoderm-** skeleton, muscles, heart, kidneys & reproductive system - **Endoderm-** lungs, liver, digestive tract & endocrine glands - Week 21-25, surfactant production begins. Most production occurs between 32-36 weeks. - Prior to the formation of the placenta the fertilised ovum is nourished by the yolk sac and trophoblastic layer. Placental circulation commences at 3 weeks and is matured at 10 weeks. The placenta produces hCG, hPL, progesterone and oestrogen. The placenta synthesis glycogen, cholesterol, fatty acids and enzymes which are used by the embryo/fetus. - **Fetal breath movements** can be detected at 10 weeks gestation and are matured at 28 weeks. - Chorionicity and amnionicity can be determined by 5 weeks gestation - DCDA- separation at 1-3 days MCDA- separation at 3-8 days\ MCMA- separation at 8-13 days - Miscarriage rates for one or both twins is 70%, **fetua papyraceus-** deceased twin remains in utero, becomes flattened and mummified. - TTS effects up to 15% of monozygotic twins, 80-90% mortality rate if not treated.  - MSS1 combined test consists of a blood test which measures two markers (PAPP-A and BhCG), available between **9-13 wks and 6 days** (but the optimal time is 9-10 wks), a Nuchal translucency scan available between **11-13wks and 6 days**. And consideration of other markers including crown-rump length, maternal age and weight, gestation and family history. MSS2 maternal serum screening test consists of a blood test which measures 4 markers and is available from **14-20wks** (optimal timing 14-18wks) and consideration of other factors - maternal age, gestation, weight and family history. Trisomy 21, 18 & 13. - **Chorionic villous sampling 11-14 weeks** - **Amniocentesis 15-18 weeks**, 10-15mL of amniotic fluid is taken for testing. Examination of the liquor for raised levels of alpha fetoprotein and acetylcholine esterase indicate the presence of a neural tube defect, most commonly spina bifida. - **Extremely preterm \